Healthcare Provider Details

I. General information

NPI: 1588648612
Provider Name (Legal Business Name): ANNE M. METZGER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GARDEN CTR 100
BROOMFIELD CO
80020-7090
US

IV. Provider business mailing address

4 GARDEN CTR 100
BROOMFIELD CO
80020-7090
US

V. Phone/Fax

Practice location:
  • Phone: 303-469-1941
  • Fax: 303-339-6251
Mailing address:
  • Phone: 303-469-1941
  • Fax: 303-339-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1838
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier61625221
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
Identifier2209187
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerEVERCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: